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Week 1 Post
Main post
The patient, center-practice safety issue, is at hospitals is Central line-associated bloodstream infection (CLABSI) rates in the Medical Intensive Care Units (MICU). CLABSI is an infection that occurs in the bloodstream through the central line is infected with germs (bacteria or a virus). This infection is laboratory-confirmed and develops within 48 hours of its placement in the central line (Spath, 2018). CLABSI is a significant patient safety issue for all healthcare systems. According to Vessnsta, Smith, Niedner, and Lin (2011), that CLABSI affects between 250,000 and 500,00 patients every year and a 30 percent mortality rate. The manifestations of the CLABSI can have significant impacts on the patient's age, existing chronic illnesses, and immune-suppressed state (Spath, 2018). The quality director at my hospital has CLABSI groups that meet every month to shows departments the data of the CLABSI rates in the hospital. The group also provides data from the National Patient Safety Goals (NPSG) to help educate the staff.
Reasons for Addressing the Problem
CLABSI is a patient safety issue that can be prevented by the healthcare system. CLABSI has an impact on the healthcare system and patient safety. CLABSI increases patient mortality rates and more extended hospital stays and can cost up to millions of dollars a year to treat the infection. Also, healthcare workers are not provided the correct education and train correctly. Most central lines are not in a sterile environment and are being inserted at the bedside alongside ultrasound in the general medical wards and the intensive care unit (Yoder-Wise, 2019). Non- tunneled catheters are the commonly used catheters though they tend to be at high risk of CLABSI. Healthcare systems need to provide training for healthcare workers and standardized treatment procedures.
Improvement Areas
The improvement areas is to observance of good hygiene, monitoring of the checklist, removal of unrequired central lines, use of subclavian vein, use of full-body drape during insertion of central venous catheters and use of experienced providers during ultrasound experiments are some of the main guidelines which can be improved during insertion (Yoder-Wise, 2019). The maintenance area also needs to be improved by doing a daily routine of disinfecting the catheters before the lines are assessed. The central line should be removed once it is no longer required to minimize the reinfection chances. The staff and patients can be educated on preventing CLABSI.
References
Spath, P. (2018). Introduction to healthcare quality management (3rded.). Chicago, IL: Health Administration Press.
Yoder-Wise, P.S. (2019). Leading and managing in nursing (7th ed.). St. Louis, MO: Mosby.
https://www.cdc.gov/hai/bsi/clabsi-resources.html
Week 2 Post
Main Discussion
Central line-associated bloodstream infection(CLABSI) is the core cause of thousands of deaths across the world. Central line-associated bloodstream infection occurs when germs pass through the central line and enter into the bloodstream. A central line is a catheter that doctors use to give medication or fluids and is also used to collect blood. It is usually placed in large veins.
Since Central line-associated bloodstream infection is a threat to practice problems, healthcare workers need to put the specific and intensive measures to prevent the CLABSI from occurring. Research shows that about 71,900 of CLABSI infections occur annually in the U.S hospitals. From the interviewed leaders, it was found that several measures were very effective in preventing the disease (Herc et al., .2017). The evident measures ensure proper adherence to the recommended insertion procedure and practices when it comes to central line application to prevent the infection where the central line is placed. Central line insertion procedures include ensuring proper hygiene in crucial body parts such hands, ensuring application of appropriate skin antiseptic, ensuring the skin prep agent has dried up completely before inserting the central line, and the nurse should use sterile gloves, cap, mask, sterile drape which is the large and sterile gown.
Other measures include; nurse ensuring central line practices are followed once the central line is put in place. Also, nurses should ensure proper hand hygiene before and after touching the line (Kramer et al. 2017). The last measure from the interviewer is to ensure the central line is removed as soon as possible after its use since earlier removal minimizes the chance of infection. Various challenges were witnessed in the data obtaining process, where the selected vital leaders were not willing to give the detailed data they were too confidential. Another challenge was the absence of key leaders, and others could not be accessed who could provide more information about the practice problem. The interviewed leaders were incorporative during the interview.
The quality indicator in the literature review is measured through several central lines associated with infection in hospitals to see the indication of the output quality. A quality indicator is used to measure the progress of the put measures in place to prevent central line-associated bloodstream infections (Pronovost et al. 2016). It is done through CLABSI surveillance, benchmarking, and public reporting. The data collected had a few gaps that need additional data, which crucial that the data be obtained from various sources, including patients. It should be understood that patients can also help prevent the occurrence of CLABSI. Another source for additional data would be the form of the nurses.
From the discussion, CLABSI, as a practice problem in medical intensive care, is highly relevant for nursing practices. This is because nurses are mostly in contact with patients in medical intensive care, where this infection is likely to occur.
References
Herc, E., Patel, P., Washer, L. L., Conlon, A., Flanders, S. A., & Chopra, V. (2017). A model to predict central-line–associated bloodstream infection among patients with peripherally inserted central catheters: the MPC score. infection control & hospital epidemiology, 38(10), 1155-1166.
Kramer, R. D., Rogers, M. A., Conte, M., Mann, J., Saint, S., & Chopra, V. (2017). Are antimicrobial peripherally inserted central catheters associated with a reduction in central line-associated bloodstream infection? A systematic review and meta-analysis. American journal of infection control, 45(2), 108-114.
Pronovost, P. J., Watson, S. R., Goeschel, C. A., Hyzy, R. C., & Berenholtz, S. M. (2016). Sustaining reductions in central line-associated bloodstream infections in Michigan intensive care units: A 10-year analysis. American Journal of Medical Quality, 31(3), 197-202.
Viana Taveira, M. R., Lima, L. S., de Araújo, C. C., & de Mello, M. J. G. (2017). Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port: A cohort study. Pediatric blood & cancer, 64(2), 336-342.
Week 3
Plan-Do-Study-Act
Plan-Do-Study-Act is an interactive, four-step problem-solving model for improving a situation or carrying out change (Jean-Louis, Edward, Patrick, & al., 2016). The model is a structured trial and error process that stands for plan, do, study, and act. Plan deals with the background, scope, goals, and causes of the issue. Do tries to find out what will work out. The study looks at the results for improvement in the process. The act dictates what to do after that and decides whether to act, abandon, or adopt. Several tools are used in the process, such as an audit tool, a processing map, and a line chart (S, W, & L, 2017). Each step of the model will help develop a plan for the central line-associated bloodstream infections (CLABSI) in an intensive care unit. The improvement is incremental and requires repeated evaluations and refinement of the process. The first procedure will be to understand the definition and rate of central line-associated bloodstream infections (CLABSI).
Second is to invite infection prevention department staff to speak to the nurses about the Quality Improvement (QI) project whereby, with your help, they will also educate staff. In this case, they will understand the prevention bundle by checking what will work out for the setting with parts of the bundle. The third step will be to check the evidence, ask the staff to perform a literature review, and understand the surveillance audits for bundle adherence.
Lastly, ask the nurses why they think the patient had the CLABSI. Later on, check on the monthly inspections to see if what we had set we are doing. As a result, you can decide whether you will act, adopt, or leave the project. The staff members will continue to offer their help in the practice project to ensure that we achieve the set goals. A favorable organizational climate will encourage staff to become involved in infection prevention and ensure that team gets infection prevention results regularly.
References
Jean-Louis, V., Edward, A., Patrick, K., & et al., &. (2016). Textbook of Critical Care. Elsevier.
S, P. K., W, S. K., & L, M. (2017). McCarthy's introduction to health care delivery: a primer for pharmacists. Burlington, MA: Jones & Bartlett Learning.
